Doctors: Be careful about laser therapy for veins

Some doctors perform profitable treatment needlessly

The treatment sounds modern and high-tech: Zap away those unsightly veins on the back of your legs with quick and painless laser therapy.

But vein experts warn that some doctors in South Florida are performing the high-profit "laser ablation" procedure too often, on patients who don't need it, solely to make money.

The laser therapy has not proven to be dangerous, but if done needlessly, it vaporizes the vein most often used for heart bypasses, doctors said. Also, the procedure seldom eliminates ugly veins that patients wanted to get rid of in the first place.

"It's such a good money maker that a lot of doctors have gotten into it. They are doing them on lots of people who don't need them," said Dr. Arthur Palamara, a Hollywood vein surgeon.

As many as 40 million Americans with varicose veins are potential customers, and Florida's large number of seniors and aging baby boomers make it a big market for the laser procedure, experts said. Insurance often covers it, making the therapy easier to sell to patients than if they had to pay out of pocket.

Overuse of the procedure is a problem across the country, but is more extensive in Florida, saidDr. Peter Gloviczki, a vein surgeon at the Mayo Clinic in Rochester, Minn., and incoming president of the national Society for Vascular Surgery.

Experts said the laser therapy is being done by heart specialists, family doctors, psychiatrists and gynecologists. Doctors buy a laser machine and can make as much as $2,000 for each 30-minute procedure.

The procedure involves making a small incision in the leg, then threading a thin tube into the vein. A laser or radiofrequency device in the tube heats the vein to make it collapse. The technique is far less invasive and causes fewer complications than earlier methods, such as surgically stripping out the vein.

"It has turned into the wild, wild west," said Dr. Jose I. Almeida, a Miami vein surgeon and instructor at the University of Miami medical school.

Palamara and Almeida said they see multiple patients every week who had healthy veins zapped needlessly by another doctor. Some patients had spider veins, small ones just under the skin that can be treated with simple saline injections, or varicose veins causing no trouble normally treated with a $20 pair of support stockings.

"This is probably the most abused procedure in the U.S. at the moment," said Dr. Russell H. Samson, an associate professor of vein surgery at Florida State University Medical School. "In my opinion … in some of these cases, it's physical abuse of the patient."

In the 10 years since it was introduced, ablation therapy has become the No. 1 vein procedure in the U.S., according to Millennium Research Group in Toronto.

More than 350,000 were done last year, up 35 percent from 2009. That's mainly because "you have all these other specialists hopping on the boat," said Millennium analyst April Lee.

Doctors said the therapy is a good option for patients with problematic varicose veins, which are vessels with weak valves that allow blood to collect in the lower legs and ankles.

The therapy is considered medically necessary when varicose veins cause pain, weaken the leg, cause major bulging and swelling, or in extreme cases, cause wounds on the skin. Insurers, including Medicare, Blue Cross Blue Shield of Florida, Aetna and Cigna, cover laser therapy only when medically necessary, spokesmen said.

But vein experts said some doctors have found ways to interpret test results to classify non-medical cases as medical issues to justify the procedure. The therapy most often is done on the saphenous vein, a large one running up the back of the leg that is best known for being harvested to use in heart bypasses.

"You have cardiovascular surgeons who spent their careers using saphenous veins for bypass, now removing healthy ones to make money," Samson said. "This is a vein you might need someday. It shouldn't just be wasted."

The national vascular group last year issued stricter standards for when laser therapy should be performed and covered by insurance, hoping to reduce the needless treatments, Gloviczki said.

Insurers may need to become tougher, Gloviczki said. The Massachusetts state health system saw enough questionable cases that it only pays for the therapy when done by extra-trained vein specialists, he said.

The advice for patients? Gloviczki suggests looking for vein clinics accredited by the Intersocietal Accreditation Commission, which follows the vascular group's standards.

Said Almeida: "If you go see a doctor for little spider veins on the leg and the doctor says you need ablation, you should seek a second opinion."